Pathology - S2B4 - Eye 1

Front 1

Where is most of the refractive power of the eye contained?

Back 1

Cornea = 39-48 diopters

Lens = 15-24 diopters

Front 2

What determines if you are Myopic or Hyperopic?

Back 2

the shape fo the eyeball

Front 3

-

Back 3

-

Front 4

What part of the eye is immunologically privileged? Why?

Back 4

Anterior Chamber b/c it doesn't receive blood flow

Front 5

Basilar Skull Fracture

Back 5

What is the cause of these symptoms?

Front 6

Basilar Skull Fracture

Back 6

What is the cause of this?

Front 7

Exophthalmos

Fatty tissue behind the globe may be infiltrated by myxedematous tissue
-Grave's disease

Back 7

What is this called? What is the cause?

Front 8

Blepharitis

Back 8

Acute inflammation of the eyelids, caused by allergen, mild trauma, etc

Front 9

Hordeolum = Sty

Back 9

Acute Folliculitis of the Meibomain or Zeis glands (sebaceous glands)

Front 10

What is the treatment for Hordeolum (Sty)?

Back 10

Hot compresses will ususally cause the Sty to "point" & drain.

Alternatively, it can be excised
-Antibiotic are rarely necessary

Front 11

What is the most common carcinoma of the eyelid? 2nd most common?

Back 11

Basal Cell CA = predilection for the lower eyelid & medial canthus

Sebaceous CA

Front 12

Subconjunctival Hemorrhage = usually due to minimal trauma
-coughing, sneezing, vomiting

Does not require treatment, but warn patient that blood will change color like a bruise

Back 12

What is seen here? What is the treatment?

Front 13

What type of Conjunctivitis is most common?

Back 13

Allergic Conjunctivitis

Front 14

What bacteria are the most common cause of Bacterial Conjunctivitis (pink eye)?

Back 14

H. influenza

S. pneumoniae

Front 15

What is the cause of Epidemic Keratoconjunctivitis that is usually contracted from under-chlorinated public swimming pools?

Back 15

Adenovirus

Front 16

This is the leading cause of blindness worldwide

Back 16

Chlamydia trachomatis

Front 17

This is the cause of Ophthalmia Neonatorum

Back 17

Gonoccal

Front 18

Pink Eye due to H. influenza
-kids complain of waking up with their eye matted shut from pus

Back 18

Dx?

Front 19

What is the treatment for Conjunctivitis?

Back 19

1. Vasoconstrictors

2. Antibiotics
-topical Erythromycin is preferred
-Contact lens-wearers should receive coverage for Pseudomonas = Ciprofloxacin, Ofloxacin, or Tobramycin

3. Ophthalmia Neonatorum requires systemic therapy = Penicillin or Ceftriaxone

Front 20

What may dry eyes cause?

Back 20

Drying & scarring of the Cornea

Front 21

What group of people is Idiopathic Dry Eye common in? What is the treatment?

Back 21

Older women = may be associated with Menopause

May also occur in younger, pregnant women

Tx = Artificial tears

Front 22

With what syndrome do you have dry eyes?

Back 22

Sjogren Syndrome = Keratoconjunctivitis Sicca

Front 23

Vascularized conjunctival tissue, which may grow over the iris, obscuring vision

Back 23

Pterygium

Front 24

What people does Pterygium commonly occur in? What is the treatment?

Back 24

Elderly

Surgical excision, often return so must be re-excised

Front 25

Pterygium

Back 25

What is this?

Front 26

This part of the Eye has more pain nerve fibers per millimeter squared than any other tissue in the body

Back 26

Cornea

Front 27

T or F: Corneal epithelium heals faster than any other tissue in the body

Back 27

True

Front 28

When does the Corneal epithelium not regenerate?

Back 28

When the Basement Membrane (Descemet's membrane) is injured

Front 29

How are Corneal Abrasions usually treated?

Back 29

1. Patch affected eye, usually heals within 24 hours
-Antibiotics are rarely necessary

2. Medicate for pain

Front 30

Eye problem in which the patient usually believes there is something in the eye, but physical exam reveals only conjunctivitis. Fluorescein may worsen the conjunctivitis

Back 30

Corneal Abrasion

Front 31

What do you not treat Herpex Simplex Corneal Ulcers with?

Back 31

Corticosteroids

Front 32

Herpes Simplex Keratitis
-"chinese character"

Back 32

What is this?

Front 33

Herpes Simplex Keratitis
-"chinese character"

Back 33

What is your diagnosis?

Front 34

Acanthemeba = severe keratoconjunctivitis in pts who do not clean their contacts properly

Back 34

What is the cause of this?

Front 35

This causes Keratoconjunctivitis in patients who do not clean their contancts lenses properly

Back 35

Acanthamoeba

Front 36

The patient was a 61 year old man who was mowing his lawn with a power mower. He was not wearing eye protection. He got something in his eye, but simply rubbed it and kept on mowing. By the next day the eye was swollen, red and pruritic. He consulted an ophthalmologist, who prescribed topical steroids. His vision worsened, and he consulted another ophthalmologist.

Back 36

Fusarium

Front 37

Fusarium

Back 37

Dx?

Front 38

Paecilomyces

Back 38

This is from a patient who had Elective Radial Keratotomy for myopia. Dx?

Front 39

A collection of disorders featuring optic neuropathy, accompanied by a characteristic excavation of the optic nerve head and progressive loss of visual field sensitivity

Back 39

Glaucoma

Front 40

What is Glaucoma?

Back 40

Any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damaged optic disk, hardening of the eyeball, and partial to complete loss of vision

Front 41

What is the most common type of Glaucoma?

Back 41

Primary Open-Angle Glaucoma

Front 42

Gradually increasing intraocular pressure, leading to visual impairment &, eventually, blindness

Back 42

Primary Open-Angle Glaucoma

Front 43

Glaucoma which is an ocular emergency, requiring intervention within 24-48 hours

Back 43

Primary Closed-angle Glaucoma

Front 44

Describe the normal flow of Aqueous Humor

Back 44

1. Fluid is produced in the Ciliary Body in the Posterior Chamber
2. Fluid then comes thru into the Cornea
3. Fluid exits thru Canal of Schlemm

Front 45

Primary Angle Closure Glaucoma
-transient apposition of the Iris at the Pupillary Margin to the Lens blocks passage of Aqueous Humor from the Posterior Chamber to the Anterior Chamber
-pressure builds up in the Posterior Chamber, bowing the Iris forward & occluding the trabecular meshwork

Back 45

What is this picture showing?

Front 46

Neovascular Membrane = Secondary Glaucoma

Back 46

What is this picture showing?

Front 47

What are some causes of Cataracts?

Back 47

1. Advanced age = MC
2. Diabetes Mellitus = osmotic damage
3. Infection = Rubella, CMV
4. Toxins or Drugs
5. Autoimmune diseases = Scleroderma
6. Physical agents = UV light, radiation

Front 48

What is the most common cause of Cataracts in the US?
Treatment?

Back 48

Aging = Senile Cataracts = "senile degeneration" of lens fibers, thought to be related to UV exposure or aging

Lens replacement

Front 49

Early Cataract

Back 49

What is seen here?

Front 50

Advanced Cataract

Back 50

What is seen here?

Front 51

Cataract

Back 51

What is seen here?

Front 52

Cataract of the Lens

Back 52

What is seen here?

Front 53

List the layers of the Retina

Back 53

1. Pigmented epithelium (Outer layer)
2. Photoreceptors; bacillary layer (outer and inner segments of cone and rod photoreceptors)
3. External (outer) limiting membrane
4. Outer nuclear (cell bodies of cones and rods)
5. Outer plexiform (cone and rod axons, horizontal cell dendrites, bipolar dendrites)
6. Inner nuclear (nuclei of horizontal cells, bipolar cells, amacrine cells, and Müller cells)
7. Inner plexiform (axons of bipolar cells and amacrine cells, dendrites of ganglion cells)
8. Ganglion cells (nuclei of ganglion cells and displaced amacrine cells)
9. Axons (nerve fibers from ganglion cells traversing the retina to leave the eye at the optic disk)
10. Internal limiting membrane (separates the retina from the vitreous)

Front 54

What are the 4 layers beneath the outermost Pigmented epithelium of the Retina, from inside (closest to Retina) to outside?

Back 54

1. Bruch's Membrane = separates the Pigmented Epithelium of the retina from the Choroid
2. Choriocapillaries
3. Choroidal blood vessels
4. Sclera = white part of eye

Front 55

Temporal Arteritis = "Giant Cell" Arteritis

can affect the Ophthalmic Artery, causing retinal infarction

Back 55

What is shown here? What is the significance?

Front 56

Retina showing:
1. Arteriolar narrowing (AV nicking)
2. Hemorrhage
3. Microaneurysms
4. Exudates
5. Cotton Wool spots = infarcted nerve fiber layer

Back 56

Hypertensive Retinopathy

Front 57

Hypertensive Retinopathy
-Arteriolar narrowing (AV nicking)
-Hemorrhage
-Microaneurysms
-Exudates
-Cotton Wool Spots (infarcted nerve fiber layer)

Back 57

What is seen here?

Front 58

Diabetic Retinopathy that has the following:
1. Hemorrhage
2. Microaneurysms
3. Exudates

Does not impair vision

Back 58

Background (Non-proliferative) Retinopathy

Front 59

Background (Non-proliferative) Retinopathy

Back 59

Dx?

Front 60

Occurs later in Diabetes, often within 5 years of death from vascular causes

Characterized by neo-vascular proliferation of the retina, which obscures vision

Retinal detachment & blindness are common

Back 60

Proliferative Retinopathy

Front 61

Proliferative Retinopathy

Back 61

Dx?

Front 62

What is an alternate name for Retinopathy of Prematurity?

Back 62

Retrolental Fibroplasia

Front 63

Describe Retinopathy of Prematurity (Retrolental Fibroplasia)

Back 63

1. Caused by high oxygen tension in Premature infants due to therapeutic oxygen

2. Proliferative retinopathy occurs, similar to that in late stage Diabetes

3. May be accompanied by Retinal Detachment & a Fibrovascular mass behind the Lens

Front 64

Systemic mycoses that is endemic in the Mississippi & Ohio River valleys that is contracted from inhalation of air-borne spores from bird or bat droppings; can cause RETINITIS

Back 64

Histoplasma captulatum

Front 65

Protozoa that is usually congenital in origin & may reactivate in HIV disease or iatrogenic immunosuppression causing brain abscesses & Retinitis

Back 65

Toxoplasmosis

Front 66

Virus that can cause Retinitis

Back 66

CMV

Front 67

Nematode that is found in Cats & Dogs; can cause Visceral Larvae Migrans resulting in Retinitis leading to blindness; most common in pediatric age group

Back 67

Toxocara

Front 68

REtinitis caused by CMV

Back 68

What is seen here?

Front 69

Retinitis caused by Histoplasmosis
-inflammation has gone deep to the Pigmented Epithelium layer = see black appearance

Back 69

What is seen here?

Front 70

Retinitis from Toxoplasmosis
-has gone into Pigmented Epithelium layer

Back 70

What is seen here?

Front 71

Toxocara
-larvae is migrating across the eye in the Aqueous Humor right behind the lens

Back 71

What is seen here?

Front 72

List the 3 types of Retinal Detachment

Back 72

1. Rhegmatogenous
2. Traction
3. Exudative

Front 73

Retinal Detachment that is associated with a retinal tear

Back 73

Rhegmatogenous

Front 74

Retinal Detachment in which adhesions are formed during diabetic retinopathy or infections & pull the retina away from the pigment layer

Back 74

Traction

Front 75

Retinal Detachment in which a collection of fluid between the retina & the pigment epithelium occurs during Choroiditis, Choroid Hemangioma, or Melanoma

Back 75

Exudative

Front 76

Most common cause of decreased visual acuity in the US

Back 76

Macular Degeneration

Front 77

What is the cause of Macular Degeneration?

Back 77

Age-related, possiblly due to toxins (Chloroquine)

may also be related to smoking, hyperlipidemia, or genetic causes

Front 78

Papilledema

Back 78

What is seen here?

Front 79

What is Papilledema?

Back 79

Optic Disc swelling that is caused by increased Intracranial pressure

Front 80

What do you NOT want to do if a patient has Papilledema?

Back 80

perform a Spinal Tap

Increased intracranial pressure will cause Cerebellar Tonsils to herniate down into the Foramen Magnum -> press on the Medulla where Respiratory Centers are -> death

Front 81

What is the most common malignancy of the eye?

Back 81

Metastatic carcinoma
-usually involving the Uveal Tract (iris, choroid, & ciliary body)

Front 82

What does Uveal Tract Melanoma arise from?

What part of the eye does NOT form Melanomas?

Back 82

Arises from Melanocytes or Nevi in the Uvea (vascular lining of the eye, including the Choroid)

Retinal Pigment Layer

Front 83

What race is more likely to get Uveal tract Melanoma?

Back 83

Caucasians

Front 84

What is the classical vignette for a Uveal tract Melanoma?

Back 84

patient presents with an enlarged liver & a glass eye

*Uveal tract Melanoma commonly metastasizes Hematogenously to the Liver

Front 85

How is Uveal tract Melanoma treated & what is the prognosis?

Back 85

Enucleation

Good prognosis if found early = 50% 15 year survival

Front 86

Anterior Segment Melanoma
-pupil tractions is seen

Back 86

What is seen here?

Front 87

Anterior Segment Melanoma

Back 87

What is seen here?

Front 88

Posterior Segment Melanoma

Back 88

What is seen here?

Front 89

Posterior Segment Melanoma

Back 89

WHat is seen here?

Front 90

Melanoma

Back 90

What is seen here?

Front 91

Malignant neoplasm that arises from immature retinal neurons & is the most common intraocular neoplasm of childhood
-usually presents within the first 2 years of life

Back 91

Retinoblastoma

Front 92

What percent of Retinoblastoma is bilateral?

Back 92

up to 25%

Front 93

What type of gene is the Rb gene? What chromosome is it located on?

Back 93

Tumor Suppressor Gene

Chr. 13

Front 94

How is Retinoblastoma treated?

Where may it spread to?

Back 94

Enucleation & chemotherapy

CNS along the optic nerve

Front 95

Explain the pathogenesis of Retinoblastoma

Back 95

Knudson's "two-hit" hypothesis:
1. First deletion si inherited in germ line in familial cases or occurs as a somatic mutation in sporadic cases

2. Second deletion results from somatic mutation in both familial % sporadic cases

Front 96

What does Retinoblastoma increase the risk of having?

Back 96

Osteosarcoma

Front 97

What percent of REtinoblastoma cases are inherited?

Back 97

6-8%

the rest are spontaneous

Front 98

Retinoblastoma
-Red Reflex is something you look for at 2-3 ft away thru your ophthalmoscope
-here you see a White reflex due to tumor

Back 98

What is seen here?

Front 99

REtinoblastoma
-fleshy tumor filling into the Vitreous Humor

Back 99

What is seen here?

Front 100

REtinoblastoma = "little blue cells"

Back 100

What is seen here?

Front 101

Retinoblastoma with "rosettes"

Back 101

What is seen here?